ENROLLMENT WILL BE LIMITED! To ensure a spot please enclose a $80.00 down payment made out to Allan Moniz and return it with this form. Enrollment includes the cost of a small prize for successful completion of  the camp. The balance of $130.00 is due the first day of camp. 
Thank You.

Any allergies or special physical conditions we should be aware of? Please let us know on a separate page!

Suspenders Circus Camp Registration Form
(Please type in the information, print out on your printer, Parents sign and mail in to us.)

Camper's Age:
For: Week 1 July 16 - 20
Last Name
First Name
Parent's Name
Address
Town, State, Zip
Email Address
Home Phone
Work
Cell / Other
Doctor's Name 
Dr.'s Phone #
Do you have
Health Insurance?
 Yes           No
Company Name
ID #
The above entrant is in appropriate health and physical condition to participate in a circus camp and will exercise good judgement and restraint so far as his or her health and well being and the well being of others are concerned. I/we expressly authorize any and all emergency medical treatment which may be necessary in the event of an accident in the case that we can not be reached in a timely manner.

Parent/Guardian signature ____________________________________________
 

Deposit enclosed :   amount: 

Please return to:
Allan Moniz, 
14 Ludlam  St.,  
Falmouth, Ma.  02540   
Phone/fax 508-540-8053 (The Suspender Line)
almo@cape.com